Purpose
Textbook outcome (TO) is a composite measure of outcome and provides superior assessment of quality of care after surgery. TO after major living donor hepatectomy (MLDH) has not been assessed. The objective of this study was to determine the rate of TO and its associated factors, after MLDH.
Methods
This was a single center retrospective review of living liver donors who underwent MLDH between 2012 and 2021 (
n
= 1022). The rate of TO and its associated factors was determined.
Results
Among 1022 living donors (of whom 693 [67.8%] were males, median age 26 [range, 18–54] years), TO was achieved in 714 (69.9%) with no donor mortality. Majority of donors met the cutoffs for individual outcome measures: 908 (88.8%) for no major complications, 904 (88.5%) for ICU stay ≤ 2 days, 900 (88.1%) for hospital stay ≤ 10 days, 990 (96.9%) for no perioperative blood transfusion, 1004 (98.2%) for no 30-day re-admission, and 1014 (99.2%) for no post-hepatectomy liver failure. Early donation era (before streamlining of donor operative pathways) was associated with failure to achieve TO [OR 1.4, CI 1.1–1.9,
P
= 0.006]. TO was achieved in 506/755 (67%) donors in the early donation era versus 208/267 (77.9%) in the later period (
P
= 0.001).
Conclusion
Despite zero mortality and low complication rate, TO was achieved in approximately 70% donors. TO was modifiable and improved with changes in donor operative pathway.
Corona Virus Disease (COVID-19) was pneumonia initially reported as epidemic in Wuhan, China due to novel Corona virus outbreak in late 2019. It has now assumed the status of pandemic with global infection spread. This infection has diversified clinical 1 -3 presentations ranging from milder symptoms like flu to severe symptoms as seen with severe respiratory distress syndromes (SARS) and middle east respiratory syndrome (MERS) having mortality rates of 10% and 37% respectively. Considering high contiguity of virus, 1,4,5 early differentiation between infected and noninfected patients is of extreme importance to prevent transmission of infection to non-infected population and health care providers. 6 Polymerase chain reaction (PCR) assay is the standard reference diagnostic modality for detection of infection
Autosomal recessive limb‐girdle muscular dystrophy‐1 (LGMDR1) is an autosomal recessive disorder characterized by progressive weakness of the proximal limb and girdle muscles. Biallelic mutations in CAPN3 are reported frequently to cause LGMDR1. Here, we describe 11 individuals from three unrelated consanguineous families that present with typical features of LGMDR1 that include proximal muscle wasting, weakness of the upper and lower limbs, and elevated serum creatine kinase. Whole‐exome sequencing identified a rare homozygous CAPN3 variant near the exon 2 splice donor site that segregates with disease in all three families. mRNA splicing studies showed partial retention of intronic sequence and subsequent introduction of a premature stop codon (NM_000070.3: c.379 + 3A>G; p.Asp128Glyfs*15). Furthermore, we observe reduced CAPN3 expression in primary dermal fibroblasts derived from an affected individual, suggesting instability and/or nonsense‐mediated decay of mutation‐bearing mRNA. Genome‐wide homozygosity mapping and single‐nucleotide polymorphism analysis identified a shared haplotype and supports a possible founder effect for the CAPN3 variant. Together, our data extend the mutational spectrum of LGMDR1 and have implications for improved diagnostics for individuals of Pakistani origin.
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